Provider Demographics
NPI:1194148247
Name:EYE CENTER OF GRAND RAPIDS-PLC
Entity type:Organization
Organization Name:EYE CENTER OF GRAND RAPIDS-PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EIYASS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBEIRUTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-719-3821
Mailing Address - Street 1:1000 E PARIS AVE SE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3691
Mailing Address - Country:US
Mailing Address - Phone:616-719-3821
Mailing Address - Fax:616-719-3740
Practice Address - Street 1:1000 E PARIS AVE SE
Practice Address - Street 2:SUITE 218
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3691
Practice Address - Country:US
Practice Address - Phone:616-719-3821
Practice Address - Fax:616-719-3740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084269207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty